飞秒激光辅助白内障手术（FLACS）同期行间质内弧形角膜切开术（ISAK）与常规超声乳化白内障吸除术联合矫正散光的人工晶状体植入术的比较
Astigmatic correction of simultaneous femtosecond laser-assisted cataract surgery (FLACS) with intrastromal arcuate keratotomy (ISAK) versus Toric intraocular Lens Impantation with conventional phacoemulsification.
机构信息
Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
出版信息
BMC Ophthalmol. 2021 Aug 14;21(1):298. doi: 10.1186/s12886-021-02059-2.
BACKGROUND
To compare the efficacies in astigmatic correction of simultaneous femtosecond laser-assisted cataract surgery (FLACS) with intrastromal arcuate keratotomy (ISAK) versus toric intraocular lens (IOL) implantation with conventional phacoemulsification in moderate astigmatism.
METHODS
A retrospective chart review was conducted for patients who had undergone cataract surgery by one surgeon. We identified patients with preoperative corneal astigmatism from + 0.75 to + 2.00 diopters (D) who had undergone astigmatic correction with FLACS with ISAK or toric IOL implantation with conventional phacoemulsification. We measured the visual acuity, intraocular pressure, automated keratometer, manifest refraction, and topography preoperatively and 1-day, 1-month, 3-month, and 6-month postoperatively. The vector analysis of refractive astigmatism was performed.
RESULTS
Of a total of 48 eyes of 48 patients, 27 eyes of 27 patients had FLACS with ISAK (AK group), and 21 eyes of 21 patients had conventional cataract surgery with toric IOL implantation (toric IOL group). Refractive astigmatism was significantly decreased in both groups. The mean preoperative and 6-month postoperative refractive astigmatism were 1.85 ± 1.07 and 0.99 ± 0.51 D, respectively, in the AK group (P = 0.028), and 1.84 ± 0.81 and 0.68 ± 0.21 D, respectively, in the toric IOL group (P < 0.001). There was no significant difference in refractive astigmatism between the two groups at 6-month postoperatively (0.99 ± 0.51 vs 0.68 ± 0.21 D, P = 0.057). At 6-month postoperatively, parameters for vector analysis of refractive astigmatism showed no statistical difference between the two groups. Corneal astigmatism was significantly decreased in the AK group. Corneal astigmatism from topography and the automated keratometer were significantly lower in the AK group 6-month postoperatively compared to toric IOL group (0.94 ± 0.40 vs. 1.53 ± 0.46 D, P = 0.018 for topography; and 0.98 ± 0.69 vs. 1.37 ± 0.41 D, P = 0.032 for the automated keratometer).
CONCLUSIONS
FLACS with ISAK could be an effective procedure for reducing astigmatism as well as toric IOL implantation in cataract surgery.
背景
比较在中度散光患者中行飞秒激光辅助白内障手术（FLACS）联合间质内弧形角膜切开术（ISAK）与散光型人工晶状体（IOL）植入术矫正散光的疗效。
方法
回顾性分析一位医生施行的白内障手术患者的病历。我们选择术前角膜散光在+0.75 至+2.00 屈光度（D）之间且行散光矫正的患者，这些患者通过 FLACS 联合 ISAK 或传统超声乳化白内障吸除术联合散光型 IOL 植入术。我们在术前、术后 1 天、1 个月、3 个月和 6 个月时测量视力、眼压、自动角膜曲率计、主觉验光和地形图。进行屈光性散光的向量分析。
结果
在 48 例 48 眼中，27 例（27 眼）行 FLACS 联合 ISAK（AK 组），21 例（21 眼）行传统白内障手术联合散光型 IOL 植入术（散光 IOL 组）。两组的屈光性散光均明显降低。AK 组术前和术后 6 个月的平均屈光性散光分别为 1.85±1.07 和 0.99±0.51 D（P=0.028），散光 IOL 组分别为 1.84±0.81 和 0.68±0.21 D（P<0.001）。术后 6 个月，两组的屈光性散光差异无统计学意义（0.99±0.51 vs 0.68±0.21 D，P=0.057）。术后 6 个月，屈光性散光向量分析的参数在两组间无统计学差异。AK 组的角膜散光明显降低。术后 6 个月，AK 组的角膜地形图和自动角膜曲率计测量的角膜散光均显著低于散光 IOL 组（0.94±0.40 vs. 1.53±0.46 D，P=0.018；0.98±0.69 vs. 1.37±0.41 D，P=0.032）。
结论
FLACS 联合 ISAK 可有效降低白内障患者的散光，与散光型 IOL 植入术的效果相当。
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